Navigating the complexities of malpractice insurance (not to mention knowing the Top 10 medical malpractice insurance companies) is a non-negotiable prerequisite for any physician focused on long-term career stability. Whether you’re a resident preparing for your first attending role, an established physician reevaluating coverage or a practice owner managing risks across multiple providers, understanding how malpractice insurance works—and which insurers lead the market—can significantly affect long-term stability.

At its core, medical malpractice insurance exists to protect physicians from the financial, legal and reputational consequences of malpractice claims. But not all policies, insurers or coverage models are created equal. Differences in financial strength, claims-handling philosophy, legal defense strategies and specialty focus can impact outcomes for physicians facing litigation.

Is medical malpractice insurance worth it?

For most physicians, malpractice insurance is essential. Even in low-risk specialties, a single claim can result in six- or seven-figure legal expenses, settlement costs and years of emotional stress.

What does malpractice insurance cover?

Medical malpractice insurance typically covers:

• Legal defense costs (attorney fees, expert witnesses, court expenses)
• Settlements or judgments awarded to plaintiffs
• Administrative and licensing board defense
• Certain coverage extensions such as consent-to-settle provisions

Defense costs alone can exceed hundreds of thousands of dollars, even when a physician is ultimately found not liable. Without coverage, those costs fall directly on the physician.

How to negotiate malpractice insurance for my physician benefit package

Many employed physicians receive malpractice insurance through their employer, but coverage terms vary widely. Key negotiation points include:

• Claims-made vs. occurrence coverage
• Who pays for tail insurance upon departure
• Policy limits and exclusions
• Consent-to-settle clauses

Negotiating these terms upfront can prevent costly surprises later, especially when transitioning between employers.

Who should have medical malpractice insurance?

Virtually every practicing physician should carry malpractice insurance, regardless of specialty or employment status.

Best medical malpractice insurance in USA

Identifying the best medical malpractice insurance in USA factors in specialty, geographic location, claims history and practice model. Large national carriers often provide broad coverage, while regional or physician-owned insurers may offer stronger specialty-specific expertise and lower premiums.

Based on industry reputation, financial strength ratings, customer reviews, and professional commentary. Some carriers frequently recommended by brokers and physician groups for their coverage consistency, claims handling and overall support for healthcare professionals are:

1. MedPro Group, part of Berkshire Hathaway, has excellent backing and a strong claims defense track record. It is often praised for stable pricing and robust claim support across specialties. 
2. The Doctors Company has strong ratings and extensive risk management resources. Physicians often highlight excellent customer service, specialized physician focus and tailored defense support. 
3. ProAssurance Group is known for flexible policy options, emphasis on risk mitigation and reputation for solid legal defense resources.
4. Coverys is an A-rated carrier with innovative risk management tools. Physicians appreciate proactive services and strong claims support. 
5. MagMutual emphasizes risk management education and physician engagement. It is often mentioned for personalized service and loyalty programs.

Is it ok to switch malpractice insurers?

Yes, it is generally okay to switch malpractice insurers, but timing and policy structure matter. Physicians with claims-made policies must ensure:

• Continuous coverage without gaps
• Proper tail or nose coverage
• Clear documentation of retroactive dates

Switching insurers can reduce premiums or improve service but only when managed carefully.

What are the 4 Cs of medical malpractice?

The 4 Cs framework evolved from decades of U.S. tort law. They are court-standardized principles that represent the four elements typically required to prove medical malpractice:

1. Care – A physician-patient relationship existed. It’s determined by evidence that the physician agreed to diagnose, treat or advise the patient
2. Compliance – The physician failed to meet the standard of care. It is heavily reliant on expert witness testimony and is determined by comparing what a reasonably competent physician in the same specialty would have done under similar circumstances
3. Causation – That failure caused harm. The plaintiff must show a direct, medically plausible link the injury would not have occurred “but for” the physician’s actions or inactions
4. Consequences – The patient suffered damages. Demonstrable damages include physical injury, emotional distress, lost income or pain and suffering

All four must be proven for liability. Understanding these principles helps physicians appreciate how insurers evaluate risk and defend claims.

Top 10 medical malpractice insurance companies

There is no single “best” malpractice insurer for every physician. Rankings vary by source, financial strength and specialty focus. Insurers frequently recognized among the top 10 medical malpractice insurance companies include:

• Large national carriers
• Physician-owned mutuals
• Regional specialists known for claims expertise and financial stability

The best policy balances cost, coverage scope, claims support and long-term stability. Even so, the best medical malpractice insurance often comes from carriers that:

• Specialize in healthcare liability
• Maintain strong AM Best ratings
• Offer specialty-specific underwriting
• Provide experienced legal defense teams

Determining the best malpractice insurance requires aligning coverage with career stage and practice environment.

What happens when a medical malpractice insurer goes bankrupt?

If a malpractice insurer becomes insolvent, state guaranty funds may step in to cover claims, but coverage limits can be lower and claims handling slower. Choosing financially stable insurers reduces this risk significantly.

Which doctors have the highest malpractice insurance rates?

Malpractice premiums vary dramatically by specialty due to differences in claim frequency and severity. There is a clear correlation between higher malpractice insurance rates and the highest paid specialties. Procedures involving high acuity, invasive techniques and long-term patient impact tend to carry both higher compensation and higher legal risk.

The most expensive malpractice insurance is usually held by surgeons practicing in high-litigation states. The most expensive malpractice insurance is usually held by surgeons practicing in high-litigation states. The top three by specialty are:

1. Obstetrics & Gynecology (OB-GYN) at $40,000–$226,000+ per year 
2. Neurosurgery at $40,000+ annually 
3. General and orthopedic surgery at $30,000–$50,000+ per year

Lower-risk specialties such as psychiatry, family medicine and pediatrics generally pay substantially less.

Top 10 largest medical malpractice insurance companies

Consisting of national commercial insurers, physician-owned mutual companies and regional carriers with dominant state presence, the top 10 largest medical malpractice insurance companies are:

1. Berkshire Hathaway Insurance, part of a global insurance conglomerate, is one of the largest writers of medical professional liability (malpractice) insurance in the U.S. market by direct premiums written. 
2. The Doctors Company is one of the largest physician-owned medical malpractice carriers in the U.S. 
3. ProAssurance Group, which was acquired by The Doctors Company in 2025, is transitioning to private ownership. 
4. MAG Mutual Companies is a large physician-owned mutual insurer writing significant malpractice premiums nationwide. 
5. MCIC Vermont is often known in regional markets and part of broader insurance access. 
6. Coverys is a large group of malpractice carriers with nationwide reach. 
7. Medical Protective (MedPro Group) is a leading malpractice insurer, part of Berkshire Hathaway. Through its affiliates, MedPro’s network and related liability products extend beyond the U.S., giving it broader global reach.
8. Steadfast Group / Crum & Forster (WR Berkley) has significant market share in malpractice liability. Through WR Berkley, it also operates internationally.
9. Hudson Insurance Group writes malpractice insurance as part of a broader insurance portfolio.
10. Liberty Mutual is U.S.-based with broad name recognition.

These carriers often offer flexible payment plans that spread annual premiums into monthly installments, making costs more manageable for physicians early in their careers. Of course, even though size can translate into financial stability, it does not automatically guarantee superior claims service.

How much is malpractice insurance per month?

Monthly malpractice insurance costs vary widely based on specialty, location and policy type. On average:

• A psychiatrist’s $5,000 – $10,500 policy has estimated monthly payments of $420 – $880. 
• An OB-GYN’s $46,000–$226,000 policy can be $3,800 – $18,800+ monthly.

Types of medical malpractice insurance

There are four common types of medical malpractice insurance, each with its own cost structure and long-term implications:

• Claims-made policies generally offer lower upfront premiums in early years but require tail coverage when leaving a job, retiring or switching insurers. Tail costs can be 1.5–2.5× the final annual premium.
• Occurrence policies have higher annual premiums than claims-made policies and the premium typically remain the same year after year. There’s no tail coverage requirement, and it is considered simpler because there are fewer future obligations.
• Tail coverage has a one-time premium typically 150%–250% of the last annual claims-made premium. It is essential protection for past acts but cannot be transferred, reused or moved to another insurer or policy.
• Nose (prior acts) coverage covers acts performed before the new policy’s start date and typically increases annual premiums by 20%–40%. It allows physicians to avoid large upfront tail expense but is not offered by all insurers.

For deeper, physician-first guidance on malpractice coverage, contract negotiation and risk management, explore the expert-backed articles, podcasts and strategic partners available in PracticeLink’s Resource Center. These trusted resources are designed to help physicians navigate complex insurance decisions with clarity and confidence—so you can stay focused on what matters most: patient care.